BC-CfE initiative, in partnership with VCH, doubles individuals kept on lifesaving treatment for opioid use disorder

(January 17, 2019|Vancouver) A first-of-its-kind initiative—based on the BC Centre for Excellence in HIV/AIDS (BC-CfE) world-renowned Treatment as Prevention strategy to curb HIV and AIDS—will roll out across all BC regional health authorities in 2019.

The successful joint initiative between the BC-CfE and Vancouver Coastal Health (VCH), the BOOST (Best Practices in Oral Opioid AgoniSt Therapy) Collaborative introduced a proactive model of treatment for opioid use disorder (OUD) to VCH clients at risk of overdose. Health care teams across Vancouver worked to implement changes to effectively identify, diagnose and engage over 1,100 people in care for OUD—doubling those kept on lifesaving treatment at three months.

“I am so grateful to everyone at the BC-CfE whose leadership and expertise addressing HIV/AIDS is now being applied to the overdose crisis,” said Judy Darcy, Minister of Mental Health and Addictions. “Bold innovations that keep people on life-saving treatment are precisely what we need to turn the tide on this devastating public health emergency.”

“The BC-CfE applied lessons from its proven effective HIV strategy, which drove a steady and consistent decline in HIV and AIDS, to address the urgent opioid overdose crisis affecting individuals and families provincewide,” said Dr. Rolando Barrios, Senior Medical Director, BC-CfE. “Small-scale improvements in care, implemented through the work of VCH health care teams, created major positive impacts on the lives of those affected by opioid use disorder. We can now apply these concepts to every region in BC.”

The number of individuals retained in opioid agonist treatment (OAT) at the 90-day mark increased from three out of ten to seven out of ten, among VCH clinics participating in the BOOST Collaborative. Through the Collaborative, health care teams created and implemented processes to better reach out to clients (for example, increasing follow-up calls and streamlining client intakes).

“I am extremely proud of the work of the VCH health care teams in successfully engaging with clients to improve their access to lifesaving opioid agonist therapy,” said Dr. Patricia Daly, Chief Medical Health Officer and Vice President, Public Health, VCH. Dr. Daly is the Former Executive Lead of the Overdose Emergency Response Centre, established by the B.C. Government in 2017. “The number of deaths related to the overdose crisis continues to be staggering. However, these tangible improvements in care can have a massive effect on people who need such supports to stay on effective treatment.”

“Programs that help to meet clients where they are and address their needs effectively are fundamental to our progress against HIV with the Treatment as Prevention strategy,” said Dr. Julio Montaner, Executive Director and Physician-in-Chief, BC-CfE. “The achievements of the BOOST Collaborative show the benefits in applying these principles to improving care and quality of life for individuals with opioid use disorder.”

The program is partly funded by Health Canada's Substance Use and Addictions Program (SUAP) aimed at supporting evidence-informed and innovative health promotion, prevention, harm reduction and treatment initiatives to address substance use issues related to legal and illegal psychoactive substances.

In 2016, the Government of BC declared the opioid drug overdose crisis a public emergency and, since then, the rate of overdose deaths has not declined. There have been more than 3,800 confirmed deaths to illicit drug overdose in B.C. since January 1, 2016.

Background

The BOOST Collaborative is based on an evidence-informed approach, supported by research showing that treatment access, dosage and retention remain the biggest barriers to effective treatment for opioid use disorder.

A significant proportion of individuals struggling with opioid use disorder will reduce illicit opioid use and remain on treatment longer with appropriate doses of methadone, buprenorphine/naloxone or slow-release oral morphine (all categorized as OAT).

The risk of morbidity and mortality decreases by 80% for individuals on effective OAT.

Recent data from the BC Coroner’s office found that, of the 1,800 deaths reviewed over a 19-month period (Jan 2016 to July 2017), none had buprenorphine present in their system.

Despite the known benefits of OAT, at baseline and before the launch of the Vancouver BOOST Collaborative, only 30-40% of individuals in Vancouver who started OAT remained on treatment at three months.

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About the British Columbia Centre for Excellence in HIV/AIDS The BC Centre for Excellence in HIV/AIDS (BC-CfE) is Canada’s largest HIV/AIDS research, treatment and education facility – nationally and internationally recognized as an innovative world leader in combating HIV/AIDS and related diseases. The made-in-BC Treatment as Prevention strategy (TasP) pioneered by BC-CfE, and supported by UNAIDS since 2011, inspired the ambitious global target for HIV treatment - known as the 90-90-90 Target - to end AIDS as a pandemic by 2030. The BC-CfE is applying TasP to therapeutic areas beyond HIV/AIDS, including viral hepatitis and substance use, to promote Targeted Disease Elimination as a means to contribute to health care sustainability. The BC-CfE works in close collaboration with key stakeholders, including government, health authorities, health care providers, academics, and the community to decrease the health burden of HIV/AIDS, hepatitis C and substance use across Canada and around the world.